Dual titration of minute ventilation and sweep gas flow to control carbon dioxide variations in patients on venovenous extracorporeal membrane oxygenation.

Autor: Masi P; Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France. paul.masi@aphp.fr.; CARMAS, Univ Paris Est Créteil, 94010, Créteil, France. paul.masi@aphp.fr.; IMRB, Univ Paris Est Créteil, INSERM, 94010, Créteil, France. paul.masi@aphp.fr., Bagate F; Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France.; CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.; IMRB, Univ Paris Est Créteil, INSERM, 94010, Créteil, France., Tuffet S; Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France.; CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.; IMRB, Univ Paris Est Créteil, INSERM, 94010, Créteil, France., Piscitelli M; Service de chirurgie cardiaque, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Faculté de Santé, F-94010, Créteil, France., Folliguet T; Service de chirurgie cardiaque, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Faculté de Santé, F-94010, Créteil, France., Razazi K; Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France.; CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.; IMRB, Univ Paris Est Créteil, INSERM, 94010, Créteil, France., De Prost N; Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France.; CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.; IMRB, Univ Paris Est Créteil, INSERM, 94010, Créteil, France., Carteaux G; Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France.; CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.; IMRB, Univ Paris Est Créteil, INSERM, 94010, Créteil, France., Mekontso Dessap A; Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, 94010, Créteil, France.; CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.; IMRB, Univ Paris Est Créteil, INSERM, 94010, Créteil, France.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2023 May 25; Vol. 13 (1), pp. 45. Date of Electronic Publication: 2023 May 25.
DOI: 10.1186/s13613-023-01138-5
Abstrakt: Background: The implantation of venovenous extracorporeal membrane oxygenation (VV-ECMO) support to manage severe acute respiratory distress syndrome generates large variations in carbon dioxide partial pressure (PaCO 2 ) that are associated with intracranial bleeding. We assessed the feasibility and efficacy of a pragmatic protocol for progressive dual titration of sweep gas flow and minute ventilation after VV-ECMO implantation in order to limit significant PaCO 2 variations.
Patients and Methods: A protocol for dual titration of sweep gas flow and minute ventilation following VV-ECMO implantation was implemented in our unit in September 2020. In this single-centre retrospective before-after study, we included patients who required VV-ECMO from March, 2020 to May, 2021, which corresponds to two time periods: from March to August, 2020 (control group) and from September, 2020 to May, 2021 (protocol group). The primary endpoint was the mean absolute change in PaCO 2 in consecutive arterial blood gases samples drawn over the first 12 h following VV-ECMO implantation. Secondary endpoints included large (> 25 mmHg) initial variations in PaCO 2 , intracranial bleedings and mortality in both groups.
Results: Fifty-one patients required VV-ECMO in our unit during the study period, including 24 in the control group and 27 in the protocol group. The protocol was proved feasible. The 12-h mean absolute change in PaCO 2 was significantly lower in patients of the protocol group as compared with their counterparts (7 mmHg [6-12] vs. 12 mmHg [6-24], p = 0.007). Patients of the protocol group experienced less large initial variations in PaCO 2 immediately after ECMO implantation (7% vs. 29%, p = 0.04) and less intracranial bleeding (4% vs. 25%, p = 0.04). Mortality was similar in both groups (35% vs. 46%, p = 0.42).
Conclusion: Implementation of our protocol for dual titration of minute ventilation and sweep gas flow was feasible and associated with less initial PaCO 2 variation than usual care. It was also associated with less intracranial bleeding.
(© 2023. The Author(s).)
Databáze: MEDLINE
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